Healthcare Provider Details

I. General information

NPI: 1104279546
Provider Name (Legal Business Name): JASMA PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BROADWAY
NEWPORT RI
02840-2937
US

IV. Provider business mailing address

100 BULLOCKS POINT AVE
RIVERSIDE RI
02915-5351
US

V. Phone/Fax

Practice location:
  • Phone: 401-845-0564
  • Fax:
Mailing address:
  • Phone: 401-437-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03350
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: